OP0116-HPR PATIENTS’ EXPERIENCES OF GROUP-BASED COGNITIVE BEHAVIOURAL THERAPY FOR INSOMNIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: A QUALITATIVE STUDY
Authors: K. M. Latocha, K. Løppenthin, P. Jennum, M. Østergaard, R. Christensen, B. A. Esbensen
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite disease-modifying anti-rheumatic drugs, residual arthritis-related symptoms and burdens are still common in patients with rheumatoid arthritis (RA) 1 . In addition, insomnia – characterised by reduced sleep quantity and quality – is highly prevalent, occurring in up to 70% of patients with RA 2 . Insomnia is associated with increased pain, fatigue, and depressive symptoms. Cognitive behavioural therapy for insomnia (CBT-I) is recommended first-line treatment for chronic insomnia 3 but has not been evaluated in patients with RA until now. Objectives The objective of this study was to explore patients’ experiences of CBT-I and how the components of CBT-I are incorporated in their sleep management. Methods Participants were patients with RA who had received CBT-I as experimental treatment for insomnia in a randomised controlled trial (RCT) 4 . Data were collected during an individual face-to-face interview using a semi-structured interview guide. The analysis was based on reflexive thematic method by Braun and Clarke 5 . Results Eleven participants (10 women and one man) from the intervention group of the RCT were interviewed. Prior to inclusion in the RCT, they had insomnia complaints for 8 years (median; interquartile range: 3;20 years). Five themes emerged: 1) When knowledge contributes to an altered perception of sleep referring to the reduced misperception and increased motivation that followed sleep education, 2) Overcoming habits and perceptions to accelerate sleep onset referring to barriers related to sleep behaviour and mindset and how stimulus control was enabling them to find meaningful behaviour and rhythm, 3) The sleep window of challenges in learning how to sleep right referring to that payoff from sleep restriction did not come easily or by magic, and commitment led to progress and gave them confidence to continue, 4) Relaxation becomes a behavioural habit and goes beyond sleep referring to a means to achieve a relaxed body and mind and how they thereby coped better with RA-related symptoms, and 5) Break the cycle and regain control referring to how awareness of a vicious cycle was central to their perception of sleep and how trust in one’s own accomplishment was crucial to reducing worrying (See Figure 1). Figure 1. The five themes with quotes from participants Overall, the participants experienced CBT-I as challenging and demanding but at the same time meaningful. The participants considered persistency, stringency, and inflexibility necessary to succeed. After the intervention, the participants had continued using those components that enabled them individually to further improve their sleep. Conclusion The process towards eliminating insomnia was a bodily experience and involved a changed mindset that altered behaviour and cognitions. References [1]PMID: 29251034 [2]PMID: 25620673 [3]PMID: 28875581 [4]PMID: 32471477 [5] https://doi.org/10.1080/2159676X.2019.1628806 Acknowledgements The authors thank the participants for generously sharing their experiences and the patient research partners for invaluable perspectives and contributions. Disclosure of Interests None declared